Nature of the Beast

When Colleen Guidy went to see plastic surgeon Billy Ringer last December, she was feeling more than a little uneasy. Two days earlier she'd had her tummy tucked and breasts enlarged, and Guidy had questions. Her right forearm was still abnormally swollen, her right hand numb, and the right side of her chest hurt much more than the left. The procedure at Ringer's Center for Plastic and Reconstructive Surgery had taken almost eight hours, twice the usual amount of time, and no one could explain why. Not to worry, she'd been told on the telephone by Ringer's staff.

As Ringer palpated her breast during the follow-up exam, Guidy screamed in pain and backed away from him. Her husband, Quint, who had accompanied her to Ringer's northwest Houston clinic, became alarmed. Fear turned to rage, however, when Ringer scoffed at her agony. "He said, 'Stop whining, you fucking pussy,' " Quint Guidy recalls. He confronted the doctor: "I told him, 'Why don't I put one of those [implants] in you, shove it, and see who's the fucking pussy.' "

Ringer's medical assistant, Traci Williamson, also witnessed the exchange (she doesn't remember the obscenity). Williamson, whose son plays soccer with Guidy's son, had referred her to Ringer in the first place. Though she was embarrassed by Ringer's remark, Williamson says, "I felt like he was the doctor, what do you do?" Besides, "It was nothing out of the ordinary. That's how he talked to everybody."

Five days later Guidy was back to have her stitches removed. A nurse friend had told her to keep an eye on the incision, that it looked unstable and might rip. Guidy complained that her stomach smelled bad. "Incision looks good," Ringer later wrote on her medical chart. During the visit, the doctor dropped another bombshell: The tip of a suture needle had broken off in pre-existing scar tissue in her chest. Again, he told her, no problem.

Concerned that her condition might require a delay of the annual family Christmas trip to Atlanta, Guidy made one more visit to the clinic a few days later. The wound was beginning to split, but Ringer packed her a to-go care kit and gave the trip his blessing. The Guidys drove to Atlanta as planned.

The day after Christmas, the incision tore apart; Guidy rushed to the emergency room, where she was given heavy doses of antibiotics to fight the infection that had taken hold in her belly; an ugly, gaping wound was left where the surrounding tissue had died. Repeated calls to Ringer yielded only a message that the clinic would be closed till after New Year's. "We were not informed that he would be out of pocket after the surgery," Guidy says.

Eventually Guidy returned to Houston and was referred by Ringer's office to another plastic surgeon -- Ringer, she was told, was in rehab for a leg injury -- who treated her briefly at no cost. After conferring with an attorney, she sought another opinion, and her new doctor suggested an X-ray. The pictures revealed that Ringer was wrong about the tip of the suture needle in her chest. Rather, doctors told Guidy, he'd left the entire needle behind, on the right-hand side.

The more the Guidys learned about what had happened, the angrier they became. They heard from Williamson that Ringer knew he'd lost the needle but had neglected to tell them. They discovered that paying cash for cosmetic surgery is not at all typical, at least outside Ringer's practice. They found out he has no liability insurance. And they learned that Ringer had not been treating a leg injury while they were desperately trying to contact him, but was instead a temporary resident of a drug rehab clinic in San Antonio.

The Guidys have filed a malpractice suit against Ringer, and they're not the only ones: Williamson and her former co-worker, Michelle Barr, have also sued him, alleging sexual harassment, drug abuse and other infractions that led to their departure. According to court records, he's settled at least four malpractice lawsuits since 1994 for undisclosed sums. The Texas State Board of Medical Examiners has placed Ringer on five years' probation for sexual misconduct with a patient.

The board has the power to suspend or revoke licenses and put bad doctors out of business. But the process for doing so is gummed up by a shortage of resources to manage the caseload from within. Since a 1988 change in the system that was supposed to make it easier to go after malpractitioners, the number of physicians sanctioned by the board has actually declined. Even when the board does try to cleanse the ranks, the cases can be dragged through the courts for years. As a result, the board often opts for probation, which physicians will accept more readily. "It's better to have them restricted and practicing instead of just out there," says board spokeswoman Jill Wiggins. "At least that way we have some kind of leverage."

That leverage only works if the terms of probation can be effectively policed, or if they're sufficient to prevent further harm to patients. Wiggins can't say if Ringer is currently under investigation for violations, but no enforcement action against him has yet been initiated.

Ringer denies all the allegations against him, even those supported by medical records and other documents. Guidy's problems, he says, were likely caused by poor circulation or the patient's failure to follow proper postsurgical instructions. As for the verbal abuse, Ringer denies he ever spoke to Guidy as she and her husband claim. "That's pretty ridiculous," he responds. "I would have said, 'Oh, no, don't be a wuss' or whatever."

He also flatly denies seeking treatment for substance abuse; asked if he has ever appropriated any narcotics from the clinic for his personal use, he offers a dismissive "Nah."

Though Ringer isn't entirely sure what's motivating his accusers, he thinks that at least the Guidys believe what they're saying, to a point. But he says he explained the potential hazards of the surgery to them, and it's sometimes hard for laypeople to understand the complexities of medicine. "She developed a couple of dead skin areas, basically," he says. "Every plastic surgeon in the world has seen that happen."

As for the others, Ringer says they're probably acting out of either greed or vengeance. "Unbelievable," he says with exasperation after being told of another charge in the litany, a letter he'd allegedly written to his lawyer confessing to misappropriating drugs from his clinic. "Next time I'm just gonna give people the money they want."

And he reserves special vitriol for Barr, whom he says he fired in January for a miserable job performance. She took out a $12,000 loan in his name without his permission, he says, and stole much of the documentation she has provided to her attorney. "When you do a neuropsychiatric evaluation," Ringer says, "you'll find she's definitely a mental case, let's put it that way."

His clinic at 821 Peakwood is still open for business, and Ringer is still nipping and tucking anyone willing to pay. Oddly, though he's carved out his niche in the plastic surgery field doing penis enlargements and other procedures on men, most of his problems have resulted from his interactions, both personal and professional, with women. "I think women are 100 percent more likely to file a lawsuit than a man," he explains. "I don't know if it's just the nature of the beast, or what."

Billy Ringer opened the Center for Plastic and Reconstructive Surgery in 1991. Originally located on the Northwest Freeway, the outpatient clinic was his only outlet; while many plastic surgeons perform more complex procedures in hospital settings, Ringer had no privileges at any other medical facilities. He used to have privileges at "all different hospitals across the city," he says (though he won't name any), but didn't bother to renew them. "I just got tired of going into all the meetings, doing all their little committees."

Ringer obtained a degree from the Texas College of Osteopathic Medicine in 1980. After a surgery internship and residency in Ohio, he received further training at an osteopathic center in Philadelphia. His penile enlargement brochure lists him as a board-certified plastic surgeon and vice president of the American Academy of Plastic and Reconstructive Surgeons, a subdivision of the American Association of Physician Specialists, which issued the board certification. None of those organizations is among those recognized by the American Board of Medical Specialties, the group that is generally considered the standard setter among the many on the medical landscape; the ABMS accepts board certification for only MDs, while Ringer's groups credential osteopaths.

The malpractice lawsuits began the same year he set up shop in Houston; Ringer would rack up eight in the ensuing decade. While court records indicate that a few were dropped by the plaintiff, at least half were settled before they got to trial. He was also co-party to more than 60 silicone implant lawsuits along with the manufacturers, though there's no indication he did anything other than install them.

In the records, Ringer is, if nothing else, consistent. He makes himself scarce from the outset: The files detail repeated, unsuccessful efforts by constables or process servers to serve him at his office. His filed responses invariably include a blanket denial of even the most specific charges. He designates himself as an expert witness regarding normal standards of care. And he doesn't carry liability insurance. Asked why not, Ringer says that having insurance "just acts as a red flag for attorneys to try and sue plastic surgeons."

The lack of insurance has deterred some plaintiffs from collecting what they felt was their due from Ringer. Frances Farrell, widow of former Astros pitcher Turk Farrell, sued Ringer in 1995 for surgery that left her with "permanent scarring and disfigurement." In a case eerily parallel to that of Colleen Guidy, Ringer had told Farrell her repairs were "doing well" and "looked good," according to court documents, after which her incision burst apart. She got a settlement, recalls her attorney, Newton Schwartz, but "it was not what the case was worth."

Others managed to tap into his cash reserves. Adriana King settled with Ringer in 1997, a case that became the basis for an investigation by the Board of Medical Examiners resulting in Ringer's probation. "We were very pleased with the settlement," says Kenneth Morris, who represented King.

Last July, Katrina Pierce settled her malpractice case against Ringer after he allegedly ruptured her breast implants by squeezing them to resolve a hardening problem. "Scarred her up pretty badly," says attorney Chad Matthews. Though Ringer says he did no more than repay Pierce the cost of her treatment, her lawyer disagrees. "The settlement was beyond the cost of the procedure," Matthews says. "He's still paying us monthly, but we have to get after him" to make the payments.

That case also brought up another thread that recurs in Ringer's collisions with the legal system. "There were allegations of trying to get insurance to pay for [the procedure] when it shouldn't have," says Matthews. Cosmetic surgery is generally not covered by health insurance policies, but many medical procedures are, such as hernia repair. Farrell's court file references an "incisional hernia" repair that was filed with the insurance company but never performed. Ringer diagnosed Guidy with an umbilical hernia and says he fixed it; according to Guidy, he was going to file it with the insurance company for reimbursement (though he says he told her to file it herself).

In fact, many of Ringer's tummy-tuck patients coincidentally had hernias, says former medical assistant Traci Williamson. It became something of a joke around the office, Williamson says; even Ringer's employees, who got free annual cosmetic surgery procedures as part of their benefits package, needed repair. "We all had hernias," she says, laughing.

For the most part, Ringer's legal troubles didn't interrupt his business.

But the King case filtered through to the Board of Medical Examiners, which brought charges against Ringer in 1995. The detailed record of hearings before an administrative law judge graphically lays out the charges and countercharges: King, an interior decorator, had agreed in late 1993 to exchange her services for a liposuction job. On two occasions at his home, she stated, he made crude sexual advances that she rebuffed. Later, while at his office for a consultation, he fondled her and exposed himself.

Ringer brought three witnesses who had worked with him at the time. They all testified that it was King who had made advances toward Ringer, that she was infatuated with him and made up all the allegations after he spurned her. But the judge found the testimony staged and lacking in credibility.

Another ex-patient, identified in the record as "K.L.," also testified. During a post-eyelid-surgery checkup, she said, Ringer asked when he was going to get to see her naked again. She hadn't realized Ringer had ever seen her naked, though she'd been under general anesthesia and had been wearing a gown. Ringer denied making the remark, though he told the judge he often told patients, "Can't wait to see you next time," and K.L. had probably misconstrued it as "Can't wait to see you naked sometime."

Based on the findings, the judge wrote, "Dr. Ringer has engaged in unprofessional and dishonorable conduct that is likely to injure the public." The terms of his probation required Ringer to undergo a psychiatric evaluation, take ethics classes, perform 120 hours of community service per year and have a chaperone with him anytime he sees a female patient. But the order wouldn't take effect until December 1998, as Ringer pursued various appeals. He took them all the way to the Texas Supreme Court, which in February refused to hear the case.

Ringer decries the board's action. "I think it's ridiculous," he says. "They had one witness saying one thing, and I had four people saying just the opposite. They decided to take the one person's story and believe that. Anybody who would read the [record] would say, 'Bullshit.' "

He also has unkind words for King: "She was a frickin' wacko."

Michelle Barr spreads piles of paper across the conference room table at the office of her attorney. Pale and tentative, with a capacity for recalling names, dates and other details, Barr is embroiled in a he-said, she-said battle with Ringer. But she has at least some of what Ringer's foes typically lack: hard evidence.

Hired as a receptionist in January 2000, Barr eventually moved up to more involved tasks that included coordinating patient needs, ordering supplies, and handling billing and collections. Later, she also assisted Ringer by preparing instruments, checking vital signs and giving medication, though she had no prior training or experience in the medical field.

Barr enjoyed her job until one evening shortly after Memorial Day. She entered Ringer's office to review the day's messages, she says, when he closed the door behind her. Claustrophobic, she immediately moved to open it. When she did, she says, "He grabbed my breast, and then he tried to stick his hand down my pants." She kicked him and ran out of the office. Barr immediately took vacation time, but agreed to return after he called her to apologize and promised it would never happen again.

Ringer finds the account laughable. "What a ridiculous accusation," he says. "She's a 280-pound redhead that I did everything in the world to help. I just can't imagine anybody sexually harassing her."

On June 21 Ringer accidentally smacked his head in his bathroom. Barr says he looked terrible the next day; she and her colleagues urged him to get medical care, but he refused. Five days later, she says, she visited him at home and called 911. He was rushed to the hospital and had emergency brain surgery. Ringer was out of work until August. His wife, who has lived in Pennsylvania the past two years, flew down to manage the clinic's financial affairs until he recovered.

When he finally returned, Barr had some new duties. Two employees, Lynnea Capunay and Kelly Cannon, had taken extended leaves, and Barr assumed responsibility for maintaining anesthesia logs and monitoring the supply of narcotics used during surgery. She found a drawer full of patient logs that listed amounts of administered drugs, especially Demerol, that were different from the official logs on file. Some of the logs clearly had been doctored, entries whited out and rewritten.

Capunay and Cannon returned to the office a month later, Barr says, and revealed the secret of the logs and other discrepancies: Ringer had been taking the drugs himself. Barr didn't believe them, however, and when she asked Ringer about the matter, he blamed his two employees. On September 13, he called an acquaintance at the Harris County Sheriff's Department, Sergeant John Trump, and reported the missing drugs. Trump arrived at the clinic with Deputy Mike Lecompte, who took a statement from Ringer.

A couple of days later, on a Saturday, Lecompte met with Barr at the office of her husband, Jimmy, a Klein Independent School District police officer. They went through the logs patient by patient. The amount of Demerol alone they chronicled as missing totaled 1,750 doses. On September 20, Lecompte arrested Capunay in the clinic parking lot and found single vials of two drugs (though no Demerol) in her possession. That day, Ringer fired both her and Cannon. Capunay later pleaded guilty to one count of possession and received deferred adjudication. There was no evidence of wrongdoing by Cannon. (Neither Capunay nor Cannon would return phone calls for comment.)

That, Barr figured, closed the case. But in October she began to notice an occasional prefilled Demerol needle missing from the inventory. Ringer had an explanation, says Barr: " 'Oh, I gave it to so-and-so in recovery,' he'd say. 'I forgot to write it down.' "

Records also show that Ringer picked up ten boxes of Demerol containing 100 needles from a local pharmacy on October 23 -- just four days after Traci Williamson had ordered four boxes from a different supplier. Williamson was off that day and unaware of the transaction. "Four boxes should have lasted the whole month," Williamson says.

On November 17, the last day before the office closed for Thanksgiving, a supplier delivered 15 boxes of Demerol containing 150 needles. When the staff returned after the holiday, Barr checked the supply. "When I went back to make sure my inventory was correct," she recalls, "every single one was gone."

The likelihood that the Demerol had been injected into patients was nil; the clinic's calls were forwarded to Barr over the holidays, and she says Ringer saw only a single patient during the break. She confronted him. This time, Ringer fessed up. "The tears started flowing," Barr says.

For the next week and a half, Jimmy Barr went to Ringer's house after work and spent the night there to make sure he was all right. According to the Barrs, Ringer eventually seemed better, and they felt that he'd gotten over an emotional hump. With Christmas vacation approaching, the prognosis appeared to be positive.

The forms to order narcotics are government-issued, and it can take weeks to get replacements. The clinic had only a single form left, so to ensure a sufficient supply until the new forms arrived, Barr and Williamson say, Ringer told them to order 20 boxes of Demerol. The drugs arrived December 21; the clinic closed the next day.

Surgeries were scheduled for several days beginning January 3, so Barr and Williamson came into the office to get everything ready. When they did the inventory, they found the Demerol boxes rewrapped in Saran instead of factory-sealed. Inside, they found all the needles -- empty. Barr called her husband, who rushed to the clinic and verified that the boxes had been opened and their contents drained. From there, Jimmy Barr says, they drove to Ringer's house. Again, the doctor confessed. "He started this little sob story, started crying that yes, there was a problem and he needed to turn his life around," Barr says.

They knew of a place outside San Antonio, the Starlite Recovery Center, where people could go for substance-abuse treatment. That night, Williamson, Barr and Ringer's niece drove him to the center, where he was admitted.

Though documents and multiple sources tell otherwise, Ringer denies he was ever a resident at Starlite. Told of evidence to the contrary, he does admit visiting the place about that time. The occasion, he says, was purely social. Ringer had produced a self-titled country-rock CD, and he was seeking feedback from a center employee who used to play with the psychedelic pop band Bubble Puppy.

Michelle Barr's stories of missing Demerol mystify him. "I have no idea what she's talking about," Ringer says. "Our records were as balanced as I'd expect them to be."

But a handwritten letter Ringer himself evidently prepared on September 7 -- the day after Barr first asked him about the missing Demerol -- indicates otherwise. Following his brain surgery, he wrote, he returned to the office to find "a large amount" of Demerol missing. "I discovered the empty used vials at my home and came to recall that I took the drugs myself." (Though the script is consistent with other documents penned by Ringer, he says he doubts the letter is in his handwriting.)

"I feel it is my moral and legal obligation to self-report this to the State Board" of Medical Examiners, the letter continues. Calling it "a temporary post-traumatic occurrence," Ringer wrote that he'd kicked the habit and would never again fall prey to temptation. "Please guide me to accomplish this today so that my sincerity is unquestionable," the letter concludes.

Addressed to his attorney, the letter apparently was never sent.

For a guy under the malpractice microscope, Ringer hasn't had much problem attracting customers. Public records list him as owning a 24-foot pleasure boat and a fleet of automobiles, including a Lincoln Mark VIII, a Mercedes convertible and a Ford Expedition and pickup truck. He also owns a piece of a cattle company, A&R Cattle, and until recently lived in a house valued at $350,000. Financial records compiled by Michelle Barr from Ringer's appointment book show he billed patients for more than $750,000 last year.

A lot of the payments were in cash. Barr says the greenbacks collected each day would be put in envelopes and stuck in a drawer. "At the end of the day, he always took it," she says. Ringer allows that patients give him cash. "Usually it's not a lot," he says. "I'll just keep it in my pocket and wander around with it for a few days until there's enough to make a deposit."

That shouldn't take too long, if Barr's records are accurate. Ringer collected $127,000 in cash last year, with another $258,000 in "unspecified" payments she says could have been by check, charge or cash -- the method was not logged into the book. Ringer also collected a disability payment last year of more than $10,000 for his head injury, according to Barr. He was supposed to get additional money, but his insurer has put a hold on further payments pending an investigation.

The cash flow from his practice might come to an abrupt halt if the Board of Medical Examiners finds that Ringer violated his probation, or if it files new charges against him as a result of the recent malpractice claims or a new investigation into drug abuse or other allegations.

That would seem to provide ample opportunity for action, but the board isn't well equipped to deal with problem doctors: If a physician compiles three malpractice suits in a five-year period that result in either convictions or settlement, the board is required by the state to conduct an investigation. But the overwhelming number of physicians who meet the criteria -- 2,500 the past five years -- make the requirement impractical, so the board developed a point system to screen out all but the most egregious cases. The system factors in the settlement amounts, among other considerations.

State law requires liability insurers to report settlement claims to the board. In Ringer's case, since he has no insurance, he must report the amounts himself. But the board has no way of knowing if the amounts doctors report are accurate or if the settlements are reported at all. Reports must be filed within 30 days, but as an internal board analysis of malpractice data states, "There have always been problems enforcing this timeframe, and reports are often received many months or even years after the claim was filed."

Probation violations could jump-start a revocation proceeding, but at least on the surface, Ringer seems to be living up to the terms. Enforcement of such items as the chaperone requirement and community service, however, are difficult to police. In 1999 Ringer claimed he did fund-raising for a local organization, Northwest Assistance Ministries. "All I did was just go out and hit people up for money," he says. Those people, according to a handwritten list, included most of his employees and several relatives, Barr and Williamson among them. Both deny ever contributing to the cause.

Last year Ringer reported that he worked off his 120 hours at the Harris County Sheriff's Department's District 1 office on Cypresswood. "Just clowning around and doing office work, really," he says. "Shuffle papers, make coffee." That might explain the note he wrote asking his office manager to coordinate dates and times with a deputy there, then type up the information to forward to the board.

The sheriff's department is responsible for investigating the missing drugs, which could potentially mean a different kind of legal trouble for Ringer. But the department has assisted Ringer in more ways than helping him work off his time. After Capunay was arrested and she and fellow employee Cannon were discharged, Barr and Williamson say, Ringer hired Deputy Mike Lecompte to work off-duty security at the clinic for more than a month -- the same Mike Lecompte who investigated the disappearance of the Demerol with Barr.

Lecompte would not confirm his employment with Ringer. "That's my personal business, not yours," he said testily. He did say he prepared a report after meeting with Barr and Ringer and then referred the case to the Harris County Organized Crime Unit; sheriff's department spokesman Robert Van Pelt was researching the status of that investigation but had not received word at press time, though Lecompte says that as far as he knows, it's ongoing.

Barr and Williamson tendered their resignations a day apart at the beginning of February. Sergeant John Trump, whom Ringer describes as an acquaintance, visited the clinic February 6, says Barr. He told her to keep her mouth shut about anything she knew, "or he would take me down," she says. "He can send my ass to jail." (Trump did not return messages left at the Cypresswood office.)

Trump's relationship with Ringer apparently extended beyond making courtesy calls; the sergeant got liposuctioned by Ringer on December 14, which Barr says (and records support) was a freebie.

Regardless of Billy Ringer's outcome with the Board of Medical Examiners or the drug investigation, he's likely going to have problems defending himself in court. The malpractice lawsuit looks like a winner for Colleen Guidy, especially with the lost suture needle glaring angrily on the X-rays. Though Ringer is sticking to his story about the needle breaking off accidentally, jurors may not be too sympathetic when they hear the testimony of Traci Williamson, who administered the anesthesia and was present throughout the surgery. During the procedure, Williamson says, Ringer suddenly yelled an obscenity. "He said he lost the needle," she recalls. "He was just yelling 'fuck' and that he had done the stupidest thing he had ever done as a surgeon."

Moreover, an independent medical examiner hired by Guidy wrote a scathing report after examining her. Guidy will need considerable medical work to repair the damage, which will include breast reconstruction, removal of the needle and the implants, the stomach wound and injury to the lymph system. "In my opinion, this is an egregious example of inappropriate surgery and care," the examiner wrote. "I strongly recommend an appropriate investigation."

The lawsuit of Michelle Barr and Traci Williamson alleging harassment and other charges will be a tougher sell. Ringer's office workers remain loyal and will no doubt testify on his behalf as they did in the malpractice case of Adriana King. But the documentation of substance abuse could well tip the balance in their favor -- if it's admitted as evidence. Though Barr says she was told to keep various records at her house and later removed a box of documents from his home at the suggestion of Ringer's relatives, he says she stole them. "She took all my original papers," he says. "She also trashed my office before she left."

Ringer says he fired Barr after returning from the Christmas break and discovering that patients had been leaving messages but not getting return calls, which was her responsibility. "She let that shit back up for blocks," he says. "She wasn't doing a damn thing."

Ringer says Barr is reacting out of fear about "what's gonna happen with the fraudulent loan she got," referring to $11,800 borrowed against a line of credit Ringer had. (She says he gave her permission, which the loan officer who arranged the deal confirms.) Barr is also upset, he says, because she had almost earned a free liposuction and would no longer be able to collect. "She wanted that done so bad," Ringer says.

The doctor is more puzzled by Williamson's collusion with Barr. "I think Traci is just the poor lost puppy syndrome," he says. "Michelle just led her down the primrose path or something."

Where that path leads is up in the air. Barr says she got a call from Ringer's relative inquiring about a settlement that might preclude publication of the story in the Press. A day later, Barr says, the relative canceled the offer to talk. Attorney Loren Klitsas, who represents Barr and Williamson as well as Guidy, says he's willing to talk, but wants above all to get Ringer out of the operating room. "I think that Dr. Ringer obviously has a lot of problems," Klitsas says, "and I feel it's my responsibility to put an end to it."

Klitsas knows, however, that the Board of Medical Examiners, not lawyers, is ultimately in control of Ringer's fate. "We can't put him in jail," he says. "We can't punch him in the nose."

"The most horrifying thing is how he slipped through the cracks with the BME," Klitsas continues. "I don't blame Ringer as much as I blame the people that are supposed to be policing him. There's no checks and balances, obviously."

Until the board does act, Ringer will be free to lengthen penises, expand breasts and drain fat without restriction. And as with Colleen Guidy, Ringer says, there are no guarantees. "Complications occur from surgery," he says. "You can't do surgery without complications."